Provider Demographics
NPI:1871648915
Name:CRUZ, CARLOS IVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:IVAN
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 HOSTOS AVE
Mailing Address - Street 2:MEDICAL EMPORIUM SUITE 214
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-806-2442
Mailing Address - Fax:787-806-2444
Practice Address - Street 1:351 HOSTOS AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-806-2442
Practice Address - Fax:787-806-2444
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD24421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics